Health care spending in the US has risen every year for decades. The factors that influence health care spending are numerous and include advances in medical technologies as well as population changes and changes in disease prevalence. Many heath care costs are covered through third party health care plans that plan sponsors (e.g., employers) offer to their members (e.g., employees). The high and growing cost of health care is a significant issue for sponsors of health care plans to cover many of the costs of health care provided to their members. Health care costs are also a significant issue for members that are increasingly asked by sponsors to share a portion of their own health care costs. Members are asked to contribute to their own health care costs in the form of higher premiums, deductibles, and co-payments under their health plans.
Identifying ways to reduce health care costs and spending is beneficial to both the sponsors as well as the members that are asked to share in the costs of their health care plans. Health plans also benefit from lower health care costs and therefore, often develop and offer programs that help sponsors and members to minimize their health care costs. For example, some health plans include wellness programs and services to help members improve their health through better eating and exercise. Although member participation in such programs may help to reduce health care costs for the member as well as the member's sponsor or employer and health plan, participation in such programs may be limited because the program is viewed as primarily a benefit for the member. The health care plan administrator may provide information about the program and sponsors may encourage their members to take advantage of such a program but other steps that could result in greater participation rates are not taken. Participation in other programs offered by the health plan administrator such as clinical programs, disease management programs, and prescription drug programs may be limited for similar reasons.
Although there are many health plan administration programs that are intended to reduce health care costs, the cost benefits for all parties are dependent upon member participation. Increasing participation requires collecting information about members to identify their health needs and providing information about health care programs that the health care plan administrator offers to determine which ones best meet the members' needs. Communication between members and health care plan administrators is important to increasing member participation. As a result, it is important for health care plan administrators to have accurate contact information as well has accurate health information about members so that members can receive information about available programs and are enrolled in the programs that best meet their needs.
Getting sponsors such as employers and their members (i.e., employees) to provide the information that is needed to increase participation in health programs can be difficult. For example, sponsors may ask their members to provide the required information to the health plan administrator but are otherwise uninvolved in the information collection. Members may be reluctant to provide contact information because they do not understand why it is needed or how it will be used. As a result, it can be difficult for the health care plan administrator to provide members with information that is not only beneficial to their health but also helpful in reducing health care costs. There is a need for a health care plan program that promotes more effective communication between a health care plan administrator and its members. There is a need for a health care plan program that engages members and establishes and tracks measurements related to member engagement. Finally, there is a need for a health care plan program that provides incentives for parties involved in the health plan—the health care plan administrator, the health care plan sponsor, and the health care plan members—to engage members in programs that are beneficial for their health, to set targets related to the health plan and member engagement, and to track metrics related to the health plan.